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x � <br /> k <br /> soi►nD oIc"taus'rs SAN JOACUIN LOCAL HEALTH DISTRICT SERVING <br /> All San Joaquin County <br /> C�01".Pres' : 1601 East Hazelton Avenue City of Manteca <br /> ,t,:. Earl Plmentel,Vice Pres. <br /> y Stockton.California 95205 City of Escalon <br /> z; Tommy Joyce.Secy. <br /> .lames F.Culbertson City of Lodi <br /> John d.Mast,M.D. JOGI KHANNA, M.D., M.P.H.. DISTRICT WEALTH OFFICER City of Tracy <br /> Wrpinia Mathews City of Ripon <br /> Schubert,0N.M. San Joaquin County <br /> Daphne Shaw �. City of Slocklon <br /> t;'�� <br /> - Harvey Williams,PhD. San Joaquin County <br /> `l <br /> AUTHORIZATION TO RELEASE ANALYTICAL RESULTS, GEOTECHNICAL DATA AND <br /> SITE ASSESSMENT INFORMATION _ <br /> Y! <br /> I , the undersigned owner and/or operator of the property and/or facility <br /> t <br /> 1. located at x'694. w, Li.��b RA. ��a4� ('�¢. ( 4FCC oococc <br /> hereby authorize &VesY0,y <br /> " to release any and all analytical results , geotechnical data and site <br /> assessment information to' the San Joaquin Local Health District as soon <br /> 1 <br /> as it is available and at the same time it is provided to me or my <br /> representative. <br /> Owner/Operator: t N � (N��t+w+4 r=sFaieN►ts)r iC1L: Jnr .nr� 7 <br /> Address SEF Phone: (zaa) e53- 37123 <br /> X690 ( Li,vv� �P " RRc7CA <br /> 1 <br /> Date: <br /> EH 23 041 3/86 <br /> i AdministrationClinical Services Environmental Health Public Health Nursing <br /> 3 468-3W ( 408-3830 468-9420 458-3880 <br /> Mr Pollution Community Services ls4or+�tory w� <br /> 488-3478 188.3820 363-3460 468.32 <br />